Clinical Management of Babesiosis
Signs and symptoms of babesiosis, should they occur, include fever, chills, sweats, headache, body or muscular aches, loss of appetite, fatigue, nausea, and vomiting. Through destruction of red blood cells, there may be hemolytic anemia. Moreover, these patients may have enlargement of the liver or spleen, and their skin can become yellow or show jaundice.
In severe cases of babesiosis, there may be low blood pressure, and this may require management with pressor agents in an intensive care unit setting. These patients may have organ failure, alteration of mental status, disseminated intravascular coagulation, acute respiratory distress, and low platelet count. This combination of findings is indicative of impending death of the patient unless the medical team implements aggressive measures to reverse the situation (Centers for Disease Control).
Groups at riskCertain groups of people are at risk for life-threatening forms of babesiosis. These include elderly individuals and others whose immune systems do not function very well. Patients with human immunodeficiency virus infection, immunosuppressive therapy because of organ transplant, long term steroid therapy, and cancer will also be at risk. Individuals with lymphoma, absent spleen, and chronic liver or kidney disease are prone to severe cases of babesiosis.
As is the case with malaria, which is also a parasitic infection, the best way to confirm the diagnosis of babesiosis is with microscopic peripheral smear of the blood. This may reveal parasites within red blood cells; however, some cases of babesiosis may be difficult to distinguish from malaria. In other words, the Plasmodium parasite which is responsible for malaria will in some cases resemble the Babesia microti parasite upon microscopic view.
Nevertheless, the similarity of microscopic findings in babesiosis and malaria is not a great obstacle to diagnosis as further tests will generally delineate which microorganism is present. A serologic blood test to facilitate the diagnosis of babesiosis is also available.
Antimicrobial therapyThe Centers for Disease Control provides information to physicians who see these patients, and the question is often about the need for antimicrobial therapy. Many patients with no symptoms from this condition do not require medication. And those who have to take antimicrobials may continue to harbor the parasite in the bloodstream for two months after the completion of treatment.
Severe cases of babesiosis must have therapy with either atovaquone and azithromycin together or the combination of clindamycin with quinine. Some of these agents are well-known for their role in the treatment of malaria. In most instances, medical therapy for babesiosis is successful.
In some states, physicians must report cases of babesiosis to the local or state health department.